去甲肾上腺素对山羊急性呼吸窘迫综合征吸入一氧化氮疗效的影响

Effects of norepinephrine on the therapeutic effect of nitric oxide inhalation in the treatment of acute respiratory distress syndrome in goat

目的 观察去甲肾上腺素(NE)对山羊感染性急性呼吸窘迫综合征(ARDS)吸入一氧化氮(NO)疗效的影响。方法 静脉注入小剂量内毒素诱导山羊感染性ARDS模型6只,在吸入体积分数为40×10-6的NO 30 min后,联合静脉泵入NE 0.5μg·kg-1·min-1治疗。通过肺动脉导管、动脉和混合静脉血气分析,测定基础、ARDS时、NO吸入治疗30 min和联合NE静脉泵入治疗30 min后血流动力学指标和肺气体交换参数。结果 NO吸入治疗能显著降低ARDS山羊的平均肺动脉压(MPAP),增加动脉氧分压(PaO2),减少肺泡动脉氧分压差[P(A-a)O2]和肺内分流率(Qs/Qt);联合NE静脉泵入不影响吸入NO后降低的MPAP,增加吸入NO后升高的PaO2,降低NO吸入后减少的P (A-a)O2和Qs/Qt,升高吸入NO后无改变的平均动脉压(P<0.05或P<0.01);吸入NO及联合应用NE治疗均不改变ARDS山羊的心排血量。结论静脉注入NE能增强吸入NO后改善感染性ARDS肺气体交换的疗效。

Objective To observe effects of norepinephrine (NE) on the therapeutic effects of nitric oxide (NO) inhalation in goats with endotoxin -induced acute respiratory distress syndrome (ARDS) . Methods A model of septic ARDS was reproduced by an intravenous infusion of low dose endotoxin in six goats, and then these animals were treated with 40× 10-6 NO inhalation. After 30 minutes, intravenous infusion of NE in dose of 0. 5 μg·kg-1·min-1 was given. The dynamic changes in gas exchange and hemodynamics were measured with the aid of Swan - Ganz catheter and arterial blood gas analysis before and after the onset of ARDS, 30 minutes after NO inhalation and administration of NE. Results Inhalation of NO rapidly reduced mean pulmonary arterial pressure (MPAP), increased PaO2, decreased alveolar -arterial partial pressure of oxygen difference[ P(A-a)O2] and intrapulmonary shunt fraction(Qs/Qt) in septic ARDS goats. These changes were more pronounced when NE was given compared with NO inhalaion alone. The combination of NO inhalation and NE infusion resulted in an increase in mean arterial pressure. Conclusion Norepinephrine enhances the beneficial effect of nitric oxide inhalation on lung gas exchange in goats with endotoxin induced acute respiratory distress syndrome.